Abscess in Parkinson’s Disease

Parkinson’s disease is the most common neurodegenerative disorder amongst the elderly group of people, who have a deficiency in the dopamine producing neurons due to an insult to the nigrostriatal region of the brain.  Dopamine is a chemical that helps in transmitting messages between the different areas of brain. This dopamine deficiency manifests in the form of loss of muscular control and coordination and leads to rigidity, stiffness, slowing of movements, freezing of gait, tremors, dyskinesia, and other motor symptoms. The various non motor symptoms include sleep disturbances, bowel and bladder dysfunction, slurred speech, difficulty in swallowing and chewing, and dysphagia. Prolonged disability and nutritional deficiencies because of the poor diet, renders the immune system weak and makes the body prone to various infections.

An abscess occurs as a result of the body’s immune system trying to fight off and localize an infection to a small area so that it does not spread to the rest of the body. People with Parkinson’s disease, and especially those who are suffering from the end stages of Parkinson’s disease, are more prone to infections. It is easy for a small infection to flare up or a tiny abscess to reach dangerous proportions because the ability of the body to fight infections is greatly reduced.

A skin abscess (boil) is the most common form of abscess that is encountered, but abscesses may also occur in the internal organs, such as the liver, kidneys, appendix, brain or lungs. Tooth abscesses are fairly common and so are abscesses of the tonsils or its surrounding tissues.

Cause of Abscess Formation

Infection is the most common cause of abscess formation. The white blood cells attack the invading organisms and try to localize the infection and thus an abscess is formed, with pus as its focal point. The most common invading organisms are Staphylococcus aureus and streptococcus, which may enter through a break in the skin or a hair follicle. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a type of staphylococcus bacteria which is resistant to the penicillin group of drugs and has been found to be increasingly involved in producing abscesses of the skin and deeper tissues.

Abscesses in the internal organs may occur due to infections already present in some organ and as a result of spread through the blood or lymphatic system.

Apart from infection, a foreign body such as a piece of glass or a thorn may also be the cause of an abscess.

Pilonidal abscess (which occurs in the crease of the buttocks) may be an example of a type of abscess which may occur easily in a Parkinson’s disease patient because of restricted movements while sitting and lying down, often for prolonged periods.

Parkinson’s disease and dental abscess

Most patients of the Parkinson’s disease opt for the dental treatments due to frequent dental abscess. The various signs and symptoms of Parkinson’s disease affect the day to day activities of the patient including a challenge for daily routine dental care. The tremors, loss of muscle – eye coordination, digital dexterity, and tongue – cheek – lip control, mitigate against the effective oral hygiene procedures. So also, the medication used to treat Parkinson’s disease causes xerostomia or dry mouth as one of the side effects. The decreased saliva production, renders the oral cavity more prone to infections like caries and fungal infections.  

The usual clinical findings consists of dryness of the mouth gingival hyperplasia and inflammation along with dental caries, and other deep-seated oral abscesses. A throbbing toothache is usually felt in case of a tooth or gum abscess. The toothache can radiate to jaw or the neck, and the patient feels sensitivity to hot and cold temperatures and sensitivity to the pressure of chewing or biting. The patient might also develop swelling in the face or cheek along with tender and swollen lymph nodes under the jaw and the neck along.

In such cases, the patients seek a dental advice. However the tremors caused by the Parkinson disease usually make the dental appointment a challenge. The patients find it difficult to open their mouth for longer time, so also the anxiety increases the Parkinson’s symptoms. Thus, these patients are generally advised to take Parkinson’s medication 60 to 90 minutes prior to the appointment so as to obtain its peak response.

It is crucial to treat these periodontal abscesses, as the bacteria launched from the infected teeth and gums carry the potential to create serious complications if they transit via bloodstream and infect other cavities of the body. Tooth abscess is usually treated by the incision and drainage to allow the pus to drain out and then it is washed with normal saline solution. Usually, a root canal treatment can also be performed if the abscess is deep seated and has reached the pulp and root canal of the tooth. If, the affected tooth cannot be saved, it is better to extract out the tooth and drain the remaining abscess to get rid of the infection. Generally, an antibiotic is prescribed after the drainage keeping in mind the possibility of its interaction with other Parkinson’s medications.

Signs and Symptoms

Symptoms will vary according to the site of the abscess but the common signs and symptoms include the following:

  • May be an inflamed, red mass of variable size, painful to the touch and occasionally with a point which may be draining pus.
  • An abscess may be accompanied by fever, headache, abdominal pain and tenderness or other toxic symptoms, especially if it involves an internal organ.
  • The abscess, which develops inside the organ or the body cavity are more difficult to identify than the normal skin abscess as there are no obvious external signs of the problem. In such cases, symptoms depend on where the abscess have developed. For example a liver abscess may manifest in the form of jaundice, whereas an abscess in the lungs may develop cough and shortness of breath. Overall, the main indicator of the abscess or an infection in the body is the development of fever.

Prevention and Treatment

Parkinson’s disease patients should be vigilant in  maintaining good personal hygiene and bring even minor cuts and injuries or a small boil to the attention of their doctor.

A hot compress applied over a small abscess may help but in no circumstances should the abscess be pressed upon too hard or a pin or needle inserted in an attempt to drain it at home. Warm compresses and elevation of the limb are beneficial for skin abscess.

Incision and drainage by a doctor is the most effective form of treatment for an abscess. After drainage, an abscess cavity is often packed with a gauze piece and cotton pad to protect the healing wound. Usually, antibiotics have no role unless the abscess has drained. An antibiotic and a pain reliever may be given after draining an abscess but a patient with Parkinson’s disease should not take any medicines without the attending doctor’s advice because of the possibility of drug interactions. Antibiotics are recommended only in persons with serious abscesses, multiple sites, rapid rate of progression, presence of cellulitis, and concurrent health condition causing immunosuppression.

 

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